A new dimension to etiopatogenesis of obsessive-compulsive disorder: Pandas [Obsesif - Kompulsif bozuklugun etyopatogenezinde yeni bir boyut: Pandas]

Childhood-onset obsessive-compulsive disorder (OCD), once considered a psychological disorder or neurosis, is now known to be a neurobiological disorder with a variety of etiologic factors, including genetic susceptibility, neurophysiological aberrations, and regional brain dysfunction. A subset of patients with pediatric onset obsessive-compulsive disorder and tic syndromes (e.g. Tourette's syndrome) have dramatic symptom onset or exacerbation associated with group A-hemolytic streptococcal (GABHS) infections. Some of these patients have been demonstrated to have antineuronal antibodies reactive with nuclei of the basal ganglion. It has been hypothesized that these patients have an immune process initiated by infection that affects the basal ganglion and causes obsessive-compulsive symptoms. The group was designated by the acronym PANDAS, for pediatric autoimmune neuropsychiatry disorders associated with streptococcal infections. This article reviews research results supporting the concept of PANDAS and discusses their limitations. Well-designed and adequately controlled studies are needed to determine whether there is a true etiologic relation between streptococcal infection and the onset or exacerbation of childhood neuropsychiatric disorders and whether the use of immune-modifying therapies for these conditions is rational.